- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,369.20 / $26,733.70
| Facility | | $6,303.00 | $16,369.20 | $26,733.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,619.96 / $29,734.87 / $39,897.76
| Facility | | $21,619.96 | $29,734.87 | $39,897.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,713.77 / $24,325.72 / $34,100.66
| Facility | | $17,713.77 | $24,325.72 | $34,100.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,421.44 / $27,016.44 / $34,058.89
| Facility | | $15,421.44 | $27,016.44 | $34,058.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,421.44 / $27,241.33 / $35,721.51
| Facility | | $15,421.44 | $27,241.33 | $35,721.51 |